The psychiatric emergency evaluation is the gateway into the mental health system. Most initial civil commitment evaluations are conducted in general hospital emergency rooms, and result, in public facilities, in involuntary treatment (DHHS, 1985). These evaluations shape the character of the mental health system by selecting its clientele.' Therefore, understanding of these evaluations and their effects is essential for rational policy making, planning and service. Having developed a reliable and valid index to measure patient standing on civil commitment criteria as clinically construed, we propose to address additional issues concerning evaluation and treatment of emergency room patients--e.g., quality of patient care, and the provision of least restrictive alternatives to hospitalization. The overall goal is to develop knowledge and tools for improved service consistent with informed policy and planning. The proposed study involves analysis of data obtained from an investigation of 772 psychiatric emergency evaluations observed in 9 public general hospitals (7 in the San Francisco Bay Area, 1 in Fresno, and 1 in Los Angeles, California) using a battery of structured data-gathering and rating instruments. Observations were conducted at 3 points-in time (1981, 1983, 1986). In addition to documenting the initial evaluation, investigators checked patients' records 1 year later at the evaluating facility, and 18 months later with California state criminal justice and vital statistics records. The follow-up record reviews were focused on possible negative consequences of evaluative procedures, including further emergency service utilization, criminal activity, and death due to trauma following release. The proposed research will: 1) develop and identify measures to inform service strategy, in psychiatric emergency; 2) identify factors which promote or pose obstacles to better emergency room evaluations and outcomes; and 3) document changes in the psychiatric emergency room evaluation process resulting from the reorientation of service ideology from preference for the dangerousness standard to a preference for a need for treatment approach to civil commitment.